Standards of accommodation for doctors in training should be adhered to.29 Where a consultant or other autonomously practising anaesthetist is required to be resident, on-call accommodation should be provided.28
An appropriately trained and experienced anaesthetist with regular commitments to burn and plastic surgery should be present during the conduct of general and regional anaesthesia for operative procedures, including those procedures requiring intravenous sedation where it has been agreed that this will be provided by the anaesthesia department.
Patients requiring burn or plastic surgery procedures should be managed by anaesthetists who have an appropriate level of training in this field. They should have a regular commitment to the burn and plastic surgery specialty and should have acquired the relevant knowledge and skills needed to care for these patients.
Because burn care is a small specialty with relatively few anaesthetists able to participate in burn care during training, each service should have plans in place to establish and maintain an appropriate anaesthesia workforce.59
If no anaesthetist is present in theatre, an appropriately trained anaesthetic nurse, ophthalmic theatre nurse or operating department practitioner should be present to monitor the patient during establishment of local anaesthesia and throughout the operative procedure. This should be their sole responsibility.2
There should be an appropriately trained theatre team including an on-call consultant anaesthetist 24/7 to provide anaesthesia for emergency head and neck surgery in head and neck cancer centres and in hospitals with an emergency department.9
Many patients with head and neck cancer have significant comorbidities that may require optimisation prior to surgery. There should be a lead anaesthetist for preoperative assessment who works closely with an appropriate preoperative assessment team.14
Where possible, surgery should be postponed until after delivery. If this is not possible, for example in cases of head and neck cancer, a multidisciplinary team approach is highly recommended, typically involving anaesthetists, surgeons, oncologists, obstetricians, midwives and paediatricians and, in cases of thyroid malignancy, endocrinologists.
All anaesthetists completing the 2021 RCoA curriculum should be able to deliver a range of safe and effective central or peripheral regional anaesthetic techniques to cover the upper and lower limb, chest and abdominal wall independently.47
